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Chap 18: Maternal
Physiologic Changes
- A woman gave birth to an infant boy 10 hours ago. Where would the nurse expect to locate this woman's fundus? a. One centimeter above the umbilicus b. Two centimeters below the umbilicus c. Midway between the umbilicus and the symphysis pubis d. Nonpalpable abdominally - answer ✅✅ANS: A Within 12 hours after delivery the fundus may be approximately 1 cm above the umbilicus. The fundus descends about 1 to 2 cm every 24 hours. Within 12 hours after delivery the fundus may be approximately 1 cm above
the umbilicus. By the sixth postpartum week the fundus normally is halfway between the symphysis pubis and the umbilicus. The fundus should be easily palpated using the maternal umbilicus as a reference point.
- Which woman is most likely to experience strong afterpains? a. A woman who experienced oligohydramnios b. A woman who is a gravida 4, para 4- 0 - 0 - 4 c. A woman who is bottle-feeding her infant d. A woman whose infant weighed 5 pounds, 3 ounces - answer ✅✅ANS: B Afterpains are more common in multiparous women. Afterpains are more noticeable with births in which the uterus was greatly distended, as in a woman who experienced polyhydramnios or a woman who delivered a large infant. Breastfeeding may cause afterpains to intensify.
b. Progesterone d. Human placental lactogen - answer ✅✅ANS: C Prolactin levels in the blood increase progressively throughout pregnancy. In women who breastfeed, prolactin levels remain elevated into the sixth week after birth. Estrogen and progesterone levels decrease markedly after expulsion of the placenta and reach their lowest levels 1 week into the postpartum period. Human placental lactogen levels decrease dramatically after expulsion of the placenta.
- Two days ago a woman gave birth to a full-term infant. Last night she awakened several times to urinate and noted that her gown and bedding were wet from profuse diaphoresis. One mechanism for the diaphoresis and diuresis that this woman is experiencing during the early postpartum period is: a.Elevated temperature caused by postpartum infection. b.Increased basal metabolic rate after giving birth c. Loss of increased blood volume associated with pregnancy.
d.Increased venous pressure in the lower extremities. - answer ✅✅ANS: C Within 12 hours of birth women begin to lose the excess tissue fluid that has accumulated during pregnancy. One mechanism for reducing these retained fluids is the profuse diaphoresis that often occurs, especially at night, for the first 2 or 3 days after childbirth. Postpartal diuresis is another mechanism by which the body rids itself of excess fluid. An elevated temperature would cause chills and may cause dehydration, not diaphoresis and diuresis. Diaphoresis and diuresis sometimes are referred to as reversal of the water metabolism of pregnancy, not as the basal metabolic rate. Postpartal diuresis may be caused by the removal of increased venous pressure in the lower extremities. A woman gave birth to a 7-pound, 3-ounce infant boy 2 hours ago. The nurse determines that the woman's bladder is distended because her fundus is now 3 cm above the umbilicus and to the right of the midline. In the immediate postpartum period, the most serious consequence likely to occur from bladder distention is:
b. Accumulation of milk in the lactiferous ducts. c. Hyperplasia of mammary tissue. d. Congestion of veins and lymphatics. - answer ✅✅ANS: D Breast engorgement is caused by the temporary congestion of veins and lymphatics, not by overproduction of colostrum, overproduction of milk, or hyperplasia of mammary tissue. A woman gave birth to a 7-pound, 6-ounce infant girl 1 hour ago. The birth was vaginal, and the estimated blood loss (EBL) was approximately 1500 mL. When assessing the woman's vital signs, the nurse would be concerned to see: a. Temperature 37.9° C, heart rate 120, respirations 20, blood pressure (BP) 90/50. b. Temperature 37.4° C, heart rate 88, respirations 36, BP 126/68.
c. temperature 38° C, heart rate 80, respirations 16, BP 110/80. d. Temperature 36.8° C, heart rate 60, respirations 18, BP 140/90. - answer ✅✅ANS: A An EBL of 1500 mL with tachycardia and hypotension suggests hypovolemia caused by excessive blood loss. An increased respiratory rate of 36 may be secondary to pain from the birth. Temperature may increase to 38° C during the first 24 hours as a result of the dehydrating effects of labor. A BP of 140/90 is slightly elevated, which may be caused by the use of oxytocic medications. Which statement by a newly delivered woman indicates that she knows what to expect about her menstrual activity after childbirth? a."My first menstrual cycle will be lighter than normal and then will get heavier every month thereafter."
a.Involutionary period because of what happens to the uterus. b.Lochia period because of the nature of the vaginal discharge. c.Mini-tri period because it lasts only 3 to 6 weeks. d.Puerperium, or fourth trimester of pregnancy. - answer ✅✅D The puerperium, also called the fourth trimester or the after birth period of pregnancy, lasts about 3 to 6 weeks. Involution marks the end of the puerperium, or the fourth trimester of pregnancy. Lochia refers to the various vaginal discharges during the puerperium, or fourth trimester of pregnancy. The self-destruction of excess hypertrophied tissue in the uterus is called: a.Autolysis.
c.Afterpain. b.Subinvolution. d.Diastasis. - answer ✅✅A Autolysis is caused by a decrease in hormone levels. Subinvolution is failure of the uterus to return to a nonpregnant state. Afterpain is caused by uterine cramps 2 to 3 days after birth. Diastasis refers to the separation of muscles. With regard to the postpartum uterus, nurses should be aware that: a.At the end of the third stage of labor it weighs approximately 500 g. b.After 2 weeks postpartum it should not be palpable abdominally. c.After 2 weeks postpartum it weighs 100 g.
c.More noticeable in births in which the uterus was overdistended. d.Alleviated somewhat when the mother breastfeeds. - answer ✅✅ANS: C A large baby or multiple babies overdistend the uterus. The cramping that causes afterbirth pains arises from periodic, vigorous contractions and relaxations, which persist through the first part of the postpartum period. Afterbirth pains are more common in multiparous women because first-time mothers have better uterine tone. Breastfeeding intensifies afterbirth pain because it stimulates contractions. Postbirth uterine/vaginal discharge, called lochia: a.Is similar to a light menstrual period for the first 6 to 12 hours. b.Is usually greater after cesarean births.
c.Will usually decrease with ambulation and breastfeeding. d.Should smell like normal menstrual flow unless an infection is present - answer ✅✅ANS: D An offensive odor usually indicates an infection. Lochia flow should approximate a heavy menstrual period for the first 2 hours and then steadily decrease. Less lochia usually is seen after cesarean births and usually increases with ambulation and breastfeeding. Which description of postpartum restoration or healing times is accurate? a.The cervix shortens, becomes firm, and returns to form within a month postpartum. b.Vaginal rugae reappear by 3 weeks postpartum. c.Most episiotomies heal within a week.
d.The first menstrual flow after childbirth usually is heavier than normal. - answer ✅✅ANS: D The first flow is heavier, but within three or four cycles, it is back to normal. Ovulation can occur within the first month, but for 70% of nonlactating women, it returns within 12 weeks after birth. Breastfeeding women take longer to resume ovulation. Because many women ovulate before their first postpartum menstrual period, contraceptive options need to be discussed early in the puerperium. As relates to the condition and reconditioning of the urinary system after childbirth, nurses should be aware that: a.Kidney function returns to normal a few days after birth. b.Diastasis recti abdominis is a common condition that alters the voiding reflex.
c.Fluid loss through perspiration and increased urinary output accounts for a weight loss of more than 2 kg during the puerperium. d.With adequate emptying of the bladder, bladder tone usually is restored 2 to 3 weeks after childbirth. - answer ✅✅ANS: C Excess fluid loss through other means occurs as well. Kidney function usually returns to normal in about a month. Diastasis recti abdominis is the separation of muscles in the abdominal wall; it has no effect on the voiding reflex. Bladder tone usually is restored 5 to 7 days after childbirth. Knowing that the condition of the new mother's breasts will be affected by whether she is breastfeeding, nurses should be able to tell their clients all the following statements except: a.Breast tenderness is likely to persist for about a week after the start of lactation.
a.Cardiac output, the pulse rate, and stroke volume all return to prepregnancy normal values within a few hours of childbirth. b.Respiratory function returns to nonpregnant levels by 6 to 8 weeks after birth. c.The lowered white blood cell count after pregnancy can lead to false-positive results on tests for infections. d.A hypercoagulable state protects the new mother from thromboembolism, especially after a cesarean birth. - answer ✅✅ANS: B Respirations should decrease to within the woman's normal prepregnancy range by 6 to 8 weeks after birth. Stroke volume increases, and cardiac output remains high for a couple of days. However, the heart rate and blood pressure return to normal quickly. Leukocytosis increases 10 to 12 days after childbirth and can obscure the diagnosis of acute infections (false-negative results). The hypercoagulable state increases the risk of thromboembolism, especially after a cesarean birth.
Which condition, not uncommon in pregnancy, is likely to require careful medical assessment during the puerperium? a.Varicosities of the legs b.Carpal tunnel syndrome c.Periodic numbness and tingling of the fingers d.Headaches - answer ✅✅ANS: D Headaches in the postpartum period can have a number of causes, some of which deserve medical attention. Total or nearly total regression of varicosities is expected after childbirth. Carpal tunnel syndrome is relieved in childbirth when the compression on the median nerve is lessened. Periodic numbness of the fingers usually disappears after birth unless carrying the baby aggravates the condition.
